Healthcare Economy

What are some of the Technology challenges of implementing a pay-for-performance system?
1. EHR Adoption: Health care providers will need to move from manual, paper-based processes to the adoption of longitudinal electronic health records (EHRs) that enable them to collect access and analyze patients’ information at the point of care.
EHRs also provide tools and decision support to manage care. The availability of patient-level clinical data and information to care providers in multiple settings like skilled nursing, home care and the doctor’s office can decrease duplication of services and errors, and improve coordination of care.
2. Interoperability: Seamless data exchange and unified standards between Hospital systems containing master data around quality measures is biggest challenge to capture one version of truth around the clinical data. Majority of hospitals invest in products like EMR, LIMS, ADT etc which are from different vendors. Since these vendors compete with each other, the exchange of data is not that easy between these systems. Moreover the BI or analytics capabilities of one product works best with its suite of products in other departments of the hospitals and provides little usability across any other competition product. Hence hospitals would need to invest separately on BI & data ware housing apart from the transactional HIS products.
3. Predictive and Real time BI instead of post facto reporting: Majority of care givers are reactive to the performance against quality measures. The BI and analytics reports generated for the care events are post facto and it takes around 4-6 months for hospitals to know around there bonus and penalty details from CMS.  The postfacto reporting tool, if does not have the ability to analyze these learning’s around pay out trends would help little in improving the quality of care.
The need of the hour is to have real time reporting tool, which has built in intelligence based on the past payouts to report present compliance levels and raise alerts, where ever, there’s a chance of breaching the compliance. It should also be able to predict the amount of payouts that a hospital can expect.
4. Flexible and scalable Reporting tool: Most P4p programs are in pilot phase and hence have evolving quality measures. Hence the IT tools deployed should be flexible and scalable to support these changing measures.
5. Key stakeholder empowerment: The intentions of the P4p programs are to improve quality of care and make payments based on the clinical outcomes rather than utilizations. The Physicians and the nurses are the key stakeholders for hospitals to realize this objective. Hence a technology should empower these stakeholders by providing them with all the information needed at their finger tips. It could mean, clinical decision support by means of allergy alerts, medication suggestions, benchmark work flows around treatment of particular disease conditions, real time access to systems over mobile, role based dashboards around key performance KPIs, remote patient monitoring.